February 2024


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Severe Obesity Increasing Among Young Children

February 2024, NCCOR

Following a period of decline, severe obesity rates among young children are now on the rise. A recent study and commentary published in Pediatrics highlight this growing risk and recommend policy solutions to address its root causes. 

The study, conducted by researchers from the Centers for Disease Control and Prevention, analyzed data from 16.6 million children aged 2 to 4 years from 2010 to 2020 enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Researchers found that the prevalence of severe obesity fell from 2010 to 2016 (2.1% to 1.8%) among all sociodemographic groups except American Indian/Alaska Native children. However, trends rebounded by the decade’s end, increasing to 2.0% in 2020. The largest increases occurred among 4-year-olds and Hispanic children. 

Severe obesity in children means their BMI is at least 20% higher than the highest 5% of children for their age and sex (≤120% of the 95th percentile). Authors of the accompanying commentary caution that severe obesity among very young children is “nearly irreversible” and increases their risk of cardiometabolic disease and early death.   

These articles underscore the need for effective prevention efforts, early identification of young children at risk for severe obesity, and access to evidence-based family healthy weight programs to support children and their families. The commentary concludes that a comprehensive approach to reducing severe childhood obesity must address multiple interrelated factors, such as food insecurity, sleep duration, diet, and screen time, and invest in greater surveillance, research, and innovative policies to address food insecurity. 

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Publications & Tools

NCCOR Toolbox: NCCOR’s Childhood Obesity Declines Factsheet Explores Attributes of Successful Initiatives

February 2024, NCCOR

NCCOR’s Childhood Obesity Declines project examined why childhood obesity rates modestly declined in the early 2010s. Learn more about the project and its findings in our summary factsheet. It explores the critical role of the socialecological model in understanding and addressing childhood obesity. It also summarizes the common attributes of successful communities, including having multi-layered initiatives, combining public health messaging with comprehensive strategies encompassing various community sectors, the need for cross-sector partnerships, and having support from influential champions. 

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The American Journal of Clinical Nutrition Launches New Article Series to Educate Physicians and other Health Care Professionals on Nutrition

January 16, 2024, The American Society for Nutrition

To educate physicians and other health care professionals on the fundamentals of nutrition, The American Journal of Clinical Nutrition has launched a new article series titled Nutrition for the Clinician. The effort supports the White House National Strategy on Hunger, Nutrition, and Health and its directives to expand nutrition knowledge of health care providers, an effort long supported by the American Society for Nutrition. Nancy Krebs, MD, MS, Professor of Pediatrics, University of Colorado School of Medicine, is the Associate Editor for the series.

Through case-based learning, Nutrition for the Clinician provides continuing education that enhances clinical reasoning and use of the best nutrition evidence in practice. Each clinical case will feature a clearly identified nutrition problem and defined learning objectives. Cases will be published in the journal’s regular issues periodically throughout the year.


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Healthy Eating Research 2023 Research Highlights

December 15, 2023, Healthy Eating Research

We are very proud of what our grantees and research network have accomplished this year, from weighing in on important nutrition policy conversations to developing resources to help parents, providers, and educators implement healthy eating recommendations for kids. Here are some of the highlights of our research from 2023.

Review of Proposed Revisions in the WIC Food Packages

In late 2022, the U.S. Department of Agriculture (USDA), announced major WIC food package revisions. Among the proposed changes were suggestions to remove juice from the food packages, reduce the maximum allowance for milk, and require that all breakfast cereal contain whole grain as the first ingredient. To understand how the proposed WIC food package changes might impact participants’ consumption behaviors, and to inform public comments, HER funded Dr. Harry Zhang to conduct a literature review entitled “A Summary of Evidence Related to Key Food Groups Targeted in the Proposed WIC Revisions.” The proposed rule received over 15,000 comments, some of which cited Dr. Zhang’s work as well as additional HER-supported research on the impacts of COVID-19-related program changesWIC app and online shopping advances, and ways to increase fruit and vegetable consumption.


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Childhood Obesity Research & News

Obesity Spiked in Children During COVID-19 Lockdowns—Only the Youngest Bounced Back

January 24, 2024, EurekAlert!

Obesity among primary school children in the UK spiked during the COVID-19 lockdown, with a 45% increase between 2019/20 and 2020/21 among 4-5-year-olds, according to a study published on January 24, 2024 in the open-access journal PLOS ONE by Iván Ochoa-Moreno from the University of Southampton, UK, and colleagues. The authors estimated that without reversals, increased obesity rates in Year 6 children alone will cost society an additional £800 million in healthcare.

During the first year of the pandemic, school closures dramatically altered the routines of young children. Cancellation of organized sports, disrupted sleep schedules, more screen time, and deterioration of healthy eating habits likely contributed to the largest single-year increase in overweight and obesity prevalence seen in children in decades. To better understand the long-term health and economic costs of rising obesity rates in young children, the authors of the study compared Body Mass Index (BMI) data from England’s National Childhood Measurement Programme (NCMP) before, during, and after the COVID-19 pandemic among children in their first and last years of primary school (aged 4-5 and 10-11 years old). Using data from two additional longitudinal cohorts in the UK, they modeled the impact of these BMI trends on adult health outcomes and costs.

The researchers observed a 45% increase in obesity prevalence during 2020-2021 in children between 4-5 years old, and a similar effect in Year 6 children. This increase was twice as high in the most deprived areas of England. While the number of overweight and obese 4-5 year olds returned to pre-pandemic levels the following year, the increases seen in older children persisted into 2022. The study estimated that this group of children will cost society an additional £800 million in healthcare, for conditions like type 2 diabetes and heart disease, over their lifetimes.

The researchers state that the persistence of weight gain in older children suggests that reversing obesity is very challenging in older age groups, while the quick reversal to pre-pandemic levels in young children highlights the promise of policies targeting children under five as a strategy to tackle obesity.

One of the study’s authors, Professor Keith Godfrey, adds: “The sharp increase in childhood obesity during the COVID-19 pandemic illustrates the profound impacts on children’s development. Alongside the escalating costs of the ongoing epidemic of childhood obesity, it is clear that more radical new policy measures are required to reduce obesity and secure wellbeing and prosperity for the country as a whole.”


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Early Breastfeeding Linked to Lower Risk of Childhood Obesity, Regardless of Mother’s Weight, NIH Study Finds

January 11, 2024, EurekAlert!

Consistently breastfeeding infants in any amount during their first three months was associated with a lower risk of childhood obesity, regardless of the mother’s body mass index (BMI) before pregnancy, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight before pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers, while the more familiar BMI assesses body weight in relation to height.

In this ECHO Cohort study, researchers found that any amount of consistent breastfeeding during an infant’s first three months was associated with lower BMIz scores, calculated later at ages between 2 and 6 years, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy compared to those categorized as overweight during the same time. (A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.)

“Our findings highlight that each additional month of breastfeeding, whether a consistent amount or exclusively, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy,” said Gayle Shipp, PhD, RDN of Michigan State University.

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico. The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

“Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity,” said Shipp.

Dr. Shipp led this collaborative research published in Pediatrics.


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Nearly 21 Million Children Expected to Receive New Grocery Benefit This Summer

January 10, 2024, U.S. Department of Agriculture

The U.S. Department of Agriculture today announced that 35 states, all five U.S. territories, and four Tribes plan to be the first to launch the new, permanent summer grocery benefits program for children – known as Summer Electronic Benefit Transfer – in summer 2024.

USDA estimates that, in total, the states, U.S. territories, and Tribes that have committed to launching the Summer EBT program in summer 2024 will serve close to 21 million children, providing a total of nearly $2.5 billion in grocery benefits. This is around 70% of the total population of children eligible for Summer EBT. USDA expects additional states and Tribes will provide Summer EBT in 2025.

Through this new program, states will provide families with $120 per eligible child for the summer to buy food at grocery stores, farmers markets or other authorized retailers – similar to how SNAP benefits are used. Participating Tribes will provide a benefit of the same amount that can be used to buy food at WIC-authorized retailers.

“Summer grocery benefits are becoming a reality for many communities across the nation and for tens of millions of children who will receive the nutrition they need to grow, learn, and thrive,” said Agriculture Secretary Tom Vilsack. “We applaud all the leaders and partners who are stepping up to make the program’s inaugural year a success. Together we’re making progress in closing the summer hunger gap and ensuring children are nourished and healthy year-round.”

Rigorous evaluations of a multi-year demonstration project showed that providing Summer EBT reduced child hunger and improved diet quality. Summer grocery benefits decreased the number of kids with very low food security by about one-third and supported healthier diets featuring more fruits, vegetables and whole grains.

The new, permanent Summer EBT program advances the goals of the Biden-Harris Administration’s White House Conference on Hunger, Nutrition and Health to enhance food and nutrition security and improve food access and affordability. It was enacted on a bipartisan basis by Congress just over one year ago.

This is the inaugural year of the program, meaning states and Tribes that do not launch the program this summer will have future opportunities to opt-in. USDA’s goal is for Summer EBT to be available nationwide as soon as possible. The Department is providing extensive assistance, trainings, tools and more to the states, U.S. territories and Tribes targeting a 2024 roll-out as well as to those planning for 2025 and beyond. Working with future implementers is a top priority.

Later this month, USDA Deputy Secretary Xochitl Torres Small will join state, U.S. territory and Tribal leaders, and partners from across the country in Baltimore to celebrate the positive difference this program will make for millions of children.

“No kid should have to spend their summer hungry, or without nutritious food,” said Agriculture Deputy Secretary Torres Small. “Summer EBT is a giant step forward in meeting the needs of our nation’s children and families throughout the year, and especially in the summer months.”

Summer EBT is one of three key mechanisms that USDA is now using to tackle child hunger during the summer months. Families are encouraged to participate in all summer nutrition programs available to them. Summer meal sites provide free meals to families across the country, and many rural communities now offer to-go or home-delivered summer meals to increase access to this vital nutrition support.


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Treatment of Obesity Must Be Multifaceted, GSA Publication Says

January 10, EurekAlert!

According to “Insights & Implications in Gerontology: The Chronic Disease of Obesity” — a new publication from the Gerontological Society of America (GSA) — overweight and obesity are now recognized as chronic health conditions with specific pathophysiologic causes, with complications if these conditions are not addressed, and with treatments that are safe and effective. And for most older adults, treating overweight and obesity can add years to their lifespan and quality to the years of life when they are healthy.

Obesity rates for adults 65 years of age and older nearly doubled from 22 percent in 1988 to 42 percent in 2020. With the new publication, GSA aims to enhance the understanding among healthcare professionals, policy makers, and consumers of obesity as a disease and the need to intently treat individuals with obesity using guideline-based and standard-informed multidisciplinary and multifaceted plans of care. It calls attention to the steps included in GSA’s Toolkit for the Management of Obesity in Older Adults and provides readers with insights into a variety of obesity care guidelines.

The faculty who oversaw the publication’s development include John A. Batsis, MD, FACP, AGSF, FGSA, FTOS, of the University of North Carolina at Chapel Hill; Rodolfo J. Galindo, MD, FACE, of the University of Miami, UMiami Health System, and Jackson Memorial Health System; Anna Pendrey, MD, of Indiana University; and Kathryn Porter Starr, PhD, RDN, of Duke University School of Medicine and Durham VA Medical Center.

Batsis emphasized the importance of challenging common, biased beliefs about people living with obesity and enhancing the importance of obesity as a disease that needs to be managed accordingly.

“Obesity was designated as a chronic disease by the American Medical Association several years ago,” he said. “The challenge here is whether it really has been implemented and accepted as part of being a chronic disease by healthcare practitioners.”

Batsis added that obesity needs to be viewed along the lines of hypertension, diabetes, high cholesterol, and other comorbidities.

“We need to consider it as a chronic disease, not as a failure of behavioral management among patients across the entire lifespan,” he said. “It’s about biology. Everybody is an individual and with each chronic disease, it’s a biological basis of what triggers the onset of the disease.”

Porter Starr discussed the importance of involving a variety of professionals in the older adult’s care team who can go beyond assessment of physiological and metabolic conditions to address social, environmental, and economic risk factors that often go unrecognized.

“We know that our older adults experience more social isolation than any other population, with over 50 percent of individuals 60 years of age an older being at risk for social isolation. We also know that social isolation may limit the nutrient density and amount of foods that are consumed. So, we may see someone who has obesity who is not actually getting all the nutrients that they need because they’re eating alone and eating prepackaged meals,” she said. “Transportation is another big issue that we don’t always talk about and ask about. Do people have transportation to and from a grocery store? Do they have the ability to get groceries or carry the groceries? Do they have the ability to be able to prepare food?”

Support for “Insights & Implications in Gerontology: The Chronic Disease of Obesity” was provided by Novo Nordisk.


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